<p> FOR THE JULY 1, 2016 THROUGH JUNE 30, 2018 BIENNIUM</p><p>Name License Number: :</p><p>This document is not a required form but an optional tool designed to assist an individual in keeping track of their training hours for renewal of their license/certification.</p><p>Continuing education is a personal responsibility. You should evaluate your skills and knowledge to determine any areas of weakness and then plan for educational opportunities within your scope of practice that improve your individual competence. Some service medical directors may require pre-approval of your refresher education, so check with your service before pursuing educational opportunities.</p><p>Continuing education may be obtained by completing a 48-hour formal Paramedic refresher course through an approved training center or by completing 48 hours of continuing education that meets the following topics and hours below (you may add additional sheets as necessary):</p><p>CPR and ACLS may not be counted in any category as it is required in addition to CEU hours.</p><p>Topic/Course Name – CPR/ACLS Date of Completion Hours may not be included in any category Within the above license period Advanced Medical 4.0 Assessment</p><p>Advanced Trauma 4.0 Assessment</p><p>Airway 2.0</p><p>Pharmacology 2.0</p><p>Venous Access and 2.0 Medication Administration</p><p>Cardiology 2.0</p><p>12-Lead Interpretation 1.0</p><p>EMT-Paramedic Training Record Page 1 OB/GYN 1.0</p><p>Operations 2.0</p><p>EMT-Paramedic Training Record Page 2 WMD/Preparedness 2.0</p><p>Pediatric Medical/Trauma Assessment and Treatment 8.0 (may be gained through completion of a PALS/ALS PEPP course within the biennium)</p><p>Flexible Content 18.0</p><p>TOTAL 48.0</p><p>Flexible CEUs may be obtained through any format. It is highly suggested that CEUs be obtained through any of the following:</p><p>. Courses approved by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) . Conferences sponsored by recognized Wisconsin organizations or hospitals . In-house training approved by the EMS service medical director </p><p>You must retain proof of attendance and course completion for at least five years. CEUs will be randomly audited and, if selected, you will be required to submit proof of attendance/course </p><p>EMT-Paramedic Training Record Page 3 completion. Failure to provide adequate documentation may result in the suspension of your license.</p><p>I certify that I have completed all the above continuing education hours and that I have maintained documentation, as required. I agree to submit proof of attendance immediately up on request.</p><p>______Signature Applicant Date</p><p>______Signature Service Director Date</p><p>______Signature Medical Director Date</p><p>EMT-Paramedic Training Record Page 4</p>